54 year old male chest pain
54 year old male patient sitting at home when he began having a sharp substernal chest pain radiating to his jaw. He is fully alert and slightly anxious also c/o shortness of breath and nausea. Skin is pale diaphoretic, lungs sounds are clear and equal. Pain is 8/10 and nothing seems to make his pain better or worse. His history is CABG and Defibrillator.
BP 110/50
RR 18
Pulse 60
No other info available
12 lead (sorry for the quality)
Local ER is 20 minutes from scene. The closest PCI center is 1 hour and 20 minutes from scene.
How would you like to proceed?
Here is the conclusion
Inferoposterior STEMI. RCA proxymal oclusion
Infeiroposterior STEMI, RCA and LCX occ
badness
He has an inferior MI – elevation in inferior leads with reciprocal changes in aVL.
Id take a posterior ECG aswell, to confirm or refute the posterior MI (I;d expect it to show elevation).
And a V4R too, to look at the right ventricle. Under my trust guidelines if there’s a RVMI and hypotension we can give fluids, so do this incase BP drops en route.
Need to go to PCI. Morphine, Aspirin, GTN (carefully cos of BP)